Spirit of Christmas - Part 3
by Melissa Rivers
Summary: It's Christmas in the ER and a few surprises abound


SPIRIT OF CHRISTMAS  
by Missy  
(missy@lexicon.net)  
  
  
DISCLAIMER: The characters of ER are the property of Michael   
Crichton, Warner Bros. Constant Productions and Amblin Television  
and to the actors who so marvellously portray them.  
  
Any comments and/or constructive criticism may be sent to the above  
e-mail address.  
  
  
PART 3/?  
  
Mark was about to push the door open, when he overheard Kerry talking  
and stopped.  
  
"..... not your fault. Your Mom and Dad both love you very much. They  
just found that they don't want to live with each other anymore." Kerry  
spoke slowly, enunciating each of the words.  
  
"But they want me to choose which one I want to live with." Jess' voice  
trembled and was a dull monotone, revealing her deficiency in hearing,  
although to Mark it appeared that she must have a small proportion.  
  
"Jess, you don't have to decide between your Mom and Dad but you will  
have to live with only one of them. I will speak with them, okay."  
  
"But I want to live with them both." Sobs now punctuated her words, a  
cry from the heart of a child who didn't understand how her safe world  
was crumbling before her.  
  
"That's not possible, sweetie."  
  
Mark decided he had overheard enough and walked in to find the raven-  
haired girl wrapped in Kerry's arms, her head cradled against her shoulder.   
She looked up at the sound of the door.  
  
"Kerry. What's happened?"  
  
"My dear brother decided it would be more interesting to go away with  
his new girlfriend for Christmas than look after his own daughter.   
Apparently, my parents are away for the evening, so I was the next  
choice." She replied without emotion, looking across at him over Jess'  
head, stroking her hair to calm the small girl.  
  
"Does he make a habit of this? You don't seem surprised." Mark was  
surprised at how calm she was. He was also surprised that a well-  
organised person like Kerry could have a brother who would just leave  
his daughter on a whim.  
  
"It's pretty much the reason his marriage broke down. Sarah just  
couldn't take the irresponsibility anymore." Jess' sobs began to subside  
as she cuddled deeper into Kerry's arms.  
  
"So what are you going to do."  
  
"Try to contact Sarah to pick her up. She wasn't too impressed that Brad  
was going to have Jess for Christmas in the first place." Her tone  
conveyed that she agreed totally with her sister-in-law.  
  
"Why don't you just take her home?"  
  
"I would if I could but we're already down by four doctors for tonight  
with the flu and Christmas holidays. It's just not possible."  
  
Mark nodded, acknowledging that they were already short-staffed as it  
was. Late December seemed to increase the workload on the ER staff.   
While the time of year was one of happiness for most people but  
intensifies the sadness and depression in a small number. It made for  
several nights of utter madness as they combined with the usual MVAs  
and GSWs.  
  
"Why don't you take your break now and see what you can organise."   
  
Kerry looked relieved at the idea. It would give her time to settle Jess  
and find Sarah.  
  
The door opened and Randi popped her head in. "Dr. Greene, Dr.  
Weaver. Dr. Anspaugh wants to see you."  
  
"Is it that time already?" Mark checked his watch, confirming that it was  
in fact after 5.00 p.m.  
  
Kerry gently moved Jess to the seat beside her, making sure she had her  
attention. "Jess. I need you to stay here. I'll be back in a moment."  
  
Mark and Kerry met Doug in the hall as they left the doctor's lounge.   
  
"I suppose this is the official appointment." Doug remarked as they all  
moved into the central work station area. There was a gathering of  
doctors, nurses and assistants who had all caught wind of the impending  
announcement.  
  
Anspaugh gained the attention of all staff in the immediate area of the  
central work station.  
  
"As you are all aware, Dr. Morganstern resigned as Chief of Emergency  
Medicine earlier this year and we have been looking for his replacement.   
There were a number of applicants for the position and I would now like  
to introduce you to Dr. Craig Goldberg, your new Chief of Emergency  
Medicine."  
  
Murmurs of surprise floated around the staff as they all looked at the new  
doctor beside Dr. Anspaugh. Standing six foot tall, he was in his mid-  
forties with dark hair, neatly trimmed to his shirt collar.  
  
"Dr. Goldberg has had extensive ER experience, his most recent  
appointment being White Memorial Hospital. I am sure you will make  
Dr. Goldberg part of our team here at County General. I would also like  
to thank Dr. Weaver for her competent handling of the department as  
Acting Chief in the interim."  
  
Standing at the entrance near the admit desk Kerry gave a small smile  
and nod of her head in acknowledgement.  
  
"I recognise a couple of faces of those I have worked with before and I  
look forward to working with you all in the future." Dr. Goldberg's  
voice had an air of authority.  
  
"I'll leave you to it, then." Dr. Anspaugh left.   
  
Mark and Doug introduced themselves to Dr. Goldberg, shaking his hand  
in turn. Mark introduced him to Jerry and Randi, and was about to  
introduce him to Carol when he interrupted Mark letting him know they  
had already met.   
  
"Aunt Kerry." Jess ran out from the lounge and came running to her aunt,  
tugging on her coat to gain her attention before signing the rest of her  
request.  
  
Dr. Goldberg frowned at the scene. "Dr. Weaver, I notice you are still  
allowing your personal problems to interfere with your professional life."  
  
His cutting remark silenced all in the area. They waited for a response  
but were all surprised when she just straightened herself up, signed to  
Jess silently, before the two left towards the cafeteria hand in hand.   
  
"Here are the summaries and reviews which have been prepared for you."   
Mark handed over an array of folders, prepared by Kerry for the new  
Chief. Successfully diverting Dr. Goldberg's attention from Kerry, he  
asked whether he would like a tour of the ER department.  
  
"No. I think I will go over these first." Dr. Goldberg looked around.   
"I'm sure I will find my way around the department quickly enough."   
His long strides took him off to the lifts to his new offices.  
  
"What was all that about?" Doug asked picking up the lab results and x-  
rays on Aiden Richards.  
  
"Kerry has worked with Dr. Goldberg before. They didn't exactly hit if  
off." Mark said as he assigned a couple of new cases on the board to  
interns and residents.  
  
"Well, few of us do with Kerry." remarked Doug. "I'm surprised she  
didn't get the position."  
  
"Mainly because she withdrew her application." Mark commented  
dryly. "I think Dr. Goldberg may test all our patience."  
  
"What do you mean and what's with the kid and Kerry?"   
  
Mark decided to answer the easier of the two questions. "Her niece.   
Apparently her brother decided to take off out of town with his latest  
girlfriend dumping Kerry with the kid."  
  
"He just left her here with Kerry working?" Doug was amazed. He  
really shouldn't be with all the cases of abuse he saw with his pedes  
cases but he never really got used to how parents could neglect and abuse  
their children.  
  
"Yeah."  
  
"Delightful family. So where's the mother?" Doug asked looking at the  
lab results as they spoke.  
  
"Kerry's trying to get in touch with her. Apparently it was a messy  
divorce and the kid is being pulled between the two of them. She's  
pretty messed up." Mark said, clicking the lid back on the marker and  
dropping it at the base of the board.  
  
"I don't know why parents can't leave their kids out of it." Doug retorted.   
  
  
"Kerry agrees with you wholeheartedly. I've told her to take a break and  
see what she can sort out with her family."  
  
Doug nodded. "Good."  
  
"We've got an MVA coming in." Chuny interrupted.   
  
"Dr. Ross, we need you in Trauma One." called Malik from the hall.   
Doug raced down to see what the problem was with the six year old boy  
from the H&R.  
  
"Ashlea, I need you to assist on an MVA." Mark said as he caught sight  
of her leaving an exam room. Immediately, she slipped the chart in the  
holder outside the door and went to assist. "Chuny get Trauma Two  
ready."   
  
The ambulance pulled up outside and they went out to meet them,  
shivering under the sprinkle of snow that fell. The elderly gray-haired  
man had been put into a C-collar and was on a backboard to ensure  
stability of his spine.   
  
"84 year old male. He sideswiped four cars before being stopped by a  
pole. Luckily no one else was hurt. BP's 160 over 100, pulse 100,  
Resps 28. Superficial head lacs. Brief LOC at scene. He was alert and  
oriented in the ambulance. He's been complaining of chest pains." The  
paramedic quickly gave the bullet as they went into Trauma Two.   
  
"Right people, on my count. One, two & over."  
  
"CBC, Chem-7, ABG, cardiac enzymes, serum, haemoglobin, 12 lead  
EKG." Mark instructed as he checked the patient's breathing, he looked  
across at Ashlea expectantly.  
  
"Cross-table CT spine, chest and pelvis x-ray." Ashlea quickly  
instructed.  
  
Ashlea slipped an oxygen mask on the man's face as Chuny connected  
up the monitors while Lily called radiology and ordered the x-rays.   
Hands flew as the necessary action was taken to insert the intravenous  
fluid and draw blood for immediate assessment at the labs.  
  
"Start a line and one unit of NS." he called out. "Can you tell me your  
name, sir."  
  
"Charles Carmichael." he responded breathlessly.  
  
"Do you know where you are?" Mark flicked his pen-light in the man's  
eyes and was shocked that Mr. Carmichael had been driving with such  
progressive cataracts in both eyes.  
  
"In the hospital."  
  
"Do you know what day it is."  
  
"Wednesday."  
  
"And the year?"  
  
"1998."   
  
Confirming that the man was alert and oriented, he then proceeded to  
track down the cause of his pain. As he questioned him, Ashlea  
performed an abdominal palpatation to check for any discomfort or  
distention.  
  
"Do you have any pain."  
  
"Yes. In my chest."   
  
"Do you feel it anywhere else."  
  
"Down my left arm and up towards my jaw."   
  
Mark noted that he is diphoretic.   
  
"Amara, could you chase up that EKG. We need it now." Mark kept his  
voice calm and even, controlling the situation. " Five mics per minute of  
atropine."  
  
"BP's 165 over 105." Chuny warned.  
  
"Mr. Carmichael, when did you start feeling this pain?"  
  
"About twenty minutes ago. That's why I was driving to the hospital. I  
should've just called the ambulance."  
  
Amara arrived with the EKG. Chuny and Amara connected the 12 leads  
to the various sites on the body to give a 3-D visual look at what was  
happening to his heart. Once connected, Mark looked at the EKG's  
readout as it followed the rhythms being produced, recognizing the signs  
of an acute MI.  
  
"Okay, give him nitro sublingually and five migs of morphine  
intravenously."  
  
As soon as the instructions were given, the required medication was  
administered. Mark completed the charts with the details of the  
presentation and his treatment. During these few minutes the pain Mr.  
Carmichael had been experiencing subsided.  
  
"Set up a nitro drip." Mark instructed, signing it off before leaving the  
Trauma room heading for the central work station to contact the  
Catheterization lab to arrange for Mr. Carmichael to undergo angioplasty.  
  
"Dr. Greene, these two police officers want to see the MVA victim."   
Jerry indicated to the two officers on the other side of the desk as Mark  
was picking up the phone.  
  
"I'm sorry but he's in no condition to be questioned at the moment."  
Mark informed them coming across to speak to them.  
  
"We will need to speak to him as soon as he is able to." The officer  
spoke firmly, underlying their urgent need to question Mr. Carmichael.  
  
"I thought he only hit a couple of cars. You're acting as if he killed  
someone."   
  
"He did. He hit two children late this afternoon. They were brought  
here for treatment. Aiden and Zoe Richards. The little girl died in  
surgery not long ago."  
  
Mark looked across at Jerry for confirmation, who only shrugged his  
shoulders in response. He hadn't heard any information on the child.  
  
"As soon as he is able to talk to you, I will let you know. Leave your  
names with Jerry." Mark said as he indicated to the tall clerk.   
  
Dialling the Cath Lab, he discussed Mr. Carmichael's case with them,  
finding they would be able to take him in about fifteen minutes. Still  
disconcerted by Zoe Richards' death, he went into Trauma One to check  
on Aiden Richards.   
  
Doug and Dr. Corday were checking out the boy's x-rays and CT scans.   
  
"What's the verdict?" asked Mark, walking up and squinting slightly at  
the screen.  
  
"CT's clear. The pelvis has been shattered by the impact and we need  
to repair the damage to his lung. The OR is ready for us now. The  
parents have signed the consent. They're up in the surgical waiting  
area." Elizabeth told him.  
  
"You lost the little girl." Mark asked.  
  
"Yes." Elizabeth said flatly. The odds for her survival were not in her  
favour to begin with but it still stung the surgeons to lose a patient.   
Pulling down the x-rays, she slipped them at the boy's feet with his chart  
as they moved the trolley out to the OR leaving Doug and Mark in their  
midst.  
  
"What happened with the MVA?" Doug asked as they walked casually  
back to the central work station.  
  
"Acute MI. I'm waiting on the Cath Lab to take him. Should be ready to  
go any moment. Apparently he's the guy who hit the kids."  
  
"Dr. Greene." Malik came rushing from Trauma Two. "Ashlea needs  
you. He's in V-fib."  
  
Mark turned on his heel and ran to assist. He raced through the swinging  
doors to Trauma Two to the static warnings of the cardiac monitors.   
  
"Bag him." Ashlea instructed as she finished intubating him. Chuny  
immediately connected the ambu-bag and Shirley did cardiac  
compressions. "I've tried a precordial thump. He's still in V-fib. Shall  
I defibrillate?"   
  
The defibrillator was already beside the trolley, ready for use.  
  
"Go ahead." Mark confirmed.   
  
"Charge to 200" she called out as she grabbed the paddles, Malik  
squirting the electrical conducting gel on the paddles. Rubbing them  
together while waiting for the machine to charge. "Clear!"  
  
The body jumped in response to the electrical charge shooting through its  
system. There was no change in the rhythm on the cardiac monitors.  
"Still in fib."  
  
"300"   
  
Malik increased the charge and Ashlea once again applied the paddles to  
the man's chest. Again, no response.  
  
"Amp of epi." The drug was inserted into the IV and given a couple of  
minutes to take effect before Ashlea gave the call to charge the  
defibrillator to 360, the maximum charge to be used.  
  
"Clear!"  
  
Still in V-fib.   
  
"Lidocaine" Waiting again for the medication to work its way through  
the system, the team worked in sequence of injecting medication and  
defibrillating every five minutes while CPR was continued to keep the  
circulation going. After twenty minutes of no change, a final attempt  
was made to save Mr. Carmichael's life.  
  
"Bolus 500 migs of berrylium." Mark called. "Charge to 360"   
  
"Clear!" Eyes watched for a change in the monitors for a regulation in  
his rhythm.   
  
They continued with the medications of dopamine, atropine and  
epinephrine in sequence between defibrillations trying to get his heart  
rhythm back to normal before they lost his pulse and there was no  
chance.  
  
"Let's call it." Mark said  
  
"Time of death. 6.56 p.m." Ashlea pulled off her gloves and picked up  
the chart to document the drugs administered, assisted by Chuny. Mark  
and the other staff left to attend to other patients.  
  
END PART 3/? 


End file.
